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Rotational vertebral artery syndrome due to compression of nondominant vertebral artery terminating in posterior inferior cerebellar artery

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Abstract

Rotational vertebral artery syndrome (RVAS) is characterized by recurrent attacks of paroxysmal vertigo, nystagmus, and ataxia induced by head rotation. We report on a patient who developed atypical RVAS due to compression of the vertebral artery (VA) terminating in the posterior inferior cerebellar artery (PICA). A 59-year-old man suffered from vertigo and nystagmus induced by leftward head rotation and oculography showed right beating horizontal-torsional and downbeat nystagmus. Cerebral angiography showed hypoplastic right VA terminating in PICA without connection to the basilar artery. The basilar artery received its flow from the left VA only and branched out both anterior inferior cerebellar arteries. Cerebral angiography revealed a complete occlusion of the right distal VA at the level of the C1–2 junction when the head was rotated to a leftward position. In contrast, the blood flow through the left vertebral and basilar arteries remained intact while turning the head to either side. The hemodynamic compromise observed in our patient with RVAS indicates that isolated vertigo and nystagmus may occur due to transient ischemia of the inferior cerebellum or lateral medulla.

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References

  1. Brandt T, Baloh RW (2005) Rotational vertebral artery occlusion; a clinical entity or various syndrome? Neurology 65:1156–1157

    Article  PubMed  CAS  Google Scholar 

  2. Choi KD, Shin HY, Kim JS, Kim SH, Kwon OK, Koo JW, Park SH, Yoon BW, Roh JK (2005) Rotational vertebral artery syndrome: oculographic analysis of nystagmus. Neurology 65:1287–1290

    Article  PubMed  Google Scholar 

  3. Choi KD, Oh SY, Park SH, Kim JH, Koo JW, Kim JS (2007) Head-shaking nystagmus in lateral medullary infarction: patterns and possible mechanisms. Neurology 68:1337–1344

    Article  PubMed  Google Scholar 

  4. Furman JM, Wall C IIIrd, Pang DL (1990) Vestibular function in periodic alternating nystagmus. Brain 113:1425–1439

    Article  PubMed  Google Scholar 

  5. Inui H, Murai T, Yane K, Matsunaga T (1996) Brainstem ischemic damage following occlusion of the blood vessels in the rat’s posterior cerebral circulation. Eur Arch Otorhinolanyngol 253:176–181

    Article  CAS  Google Scholar 

  6. Jeong HS, Oh JY, Kim JS, Kim J, Lee AY, Oh SY (2007) Periodic alternating nystagmus in isolated nodular infarction. Neurology 68:956–957

    Article  PubMed  Google Scholar 

  7. Kim JS, Lopez I, DiPatre PL, Liu F, Ishiyama A, Baloh RW (1999) Internal auditory artery infarction: clinicopathologic correlation. Neurology 52:40–44

    PubMed  CAS  Google Scholar 

  8. Kuether TA, Nesbit GM, Clark WM, Barnwell SL (1997) Rotational vertebral artery occlusion: a mechanism of vertebrobasilar insufficiency. Neurosurgery 41:427–432

    Article  PubMed  CAS  Google Scholar 

  9. Lee H (2009) Neuro-otological aspects of cerebellar stroke syndrome. J Clin Neurol 5:65–73

    Article  PubMed  Google Scholar 

  10. Lee H, Sohn SI, Cho YW, Lee SR, Ahn BH, Park BR, Baloh RW (2006) Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology 67:1178–1183

    Article  PubMed  CAS  Google Scholar 

  11. Lee SH, Kim JS (2010) Benign paroxysmal positional vertigo. J Clin Neurol 6:51–63

    Article  PubMed  Google Scholar 

  12. Marti S, Hegemann S, von Büdingen H-C, Baumgartner RW, Straumann D (2008) Rotational vertebral artery syndrome: 3D kinematics of nystagmus suggest bilateral labyrinthine dysfunction. J Neurol 255:663–667

    Article  PubMed  Google Scholar 

  13. Matsuyama T, Morimoto T, Skaki T (1997) Bow Hunter’s stroke caused by a nondominant vertebral artery occlusion: case report. Neurosurgery 41:1391–1395

    Article  Google Scholar 

  14. Moon IS, Kim JS, Choi KD, Kim MJ, Oh SY, Lee H, Lee HS, Park SH (2009) Isolated nodular infarction. Stroke 40:487–491

    Article  PubMed  Google Scholar 

  15. Oh YM, Choi KD, Oh SY, Kim JS (2006) Periodic alternating nystagmus with circumscribed nodular lesion. Neurology 67:399

    Article  PubMed  Google Scholar 

  16. Rambold H, Helmchen C (2005) Spontaneous nystagmus in dorsolateral medullary infarction indicates vestibular semicircular canal imbalance. J Neurol Neurosurg Psychiatry 7:88–94

    Article  Google Scholar 

  17. Strupp M, Planck JH, Arbusow V, Steiger HJ, Brückmann H, Brandt T (2000) Rotational vertebral artery occlusion syndrome with vertigo due to “labyrinthine excitation”. Neurology 54:1376–1379

    PubMed  CAS  Google Scholar 

  18. Tatlow W, Bammer H (1957) Syndromes of vertebral artery compression. Neurology 7:331–340

    Google Scholar 

  19. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1996) Arterial territories of human brain: brainstem and cerebellum. Neurology 47:1125–1135

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (A080750).

Conflict of interest

Drs. Noh and Kwon, and MSc. Kim report no disclosure. Dr. Kim, corresponding author, serves as an Associate Editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Korean Society of Clinical Neurophysiology, Research in Vestibular Science, Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, and Journal of Neuro-ophthalmology; and received research support from SK Chemicals, Co. Ltd.

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Authors and Affiliations

  1. Department of Neurology, College of Medicine, Seoul National University, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Seoul, South Korea

    Young Noh, Hyo-Jung Kim & Ji Soo Kim

  2. Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea

    O-Ki Kwon

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  1. Young Noh
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  2. O-Ki Kwon
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  3. Hyo-Jung Kim
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  4. Ji Soo Kim
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Correspondence to Ji Soo Kim.

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Supplementary video. Rightward head-turning induces no vertigo or nystagmus. On turning the head leftward, with a latency of several seconds, the patient develops vertigo and right beating horizontal-torsional nystagmus with a downbeat component. On resuming neutral head position, the nystagmus reverses its directions and undergoes another reversal about 10 s later. (MPG 14,190 kb)

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Noh, Y., Kwon, OK., Kim, HJ. et al. Rotational vertebral artery syndrome due to compression of nondominant vertebral artery terminating in posterior inferior cerebellar artery. J Neurol 258, 1775–1780 (2011). https://doi.org/10.1007/s00415-011-6005-1

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